Korean J Gastroenterol.  2020 Jan;75(1):46-49. 10.4166/kjg.2020.75.1.46.

Adult Ileocolic Intussusception Caused by Diffuse Large B Cell Lymphoma

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. gasong@pusan.ac.kr

Abstract

Intussusception is a medical condition, in which a proximal part of the intestine folds into the distal intestine. Adult intussusceptions are rare and account for approximately 5% of all cases of intussusceptions. The anatomical leading points include tumors, diverticulums, polyps, and strictures in 80-90% of adult intussusceptions, and 65% of colon intussusceptions and 30% of small bowel intussusceptions originate from malignant tumors. Treatments for adult intussusception have not been established, but most cases require surgical treatment. The gastrointestinal tract is the most common extranodal site for non-Hodgkin lymphoma. The symptoms are mostly non-specific, but they rarely lead to complications, such as bleeding, perforation, and intussusception. Furthermore, few cases of primary gastrointestinal lymphomas causing intussusception have been reported. This paper reports a case of small bowel diffuse large B cell lymphoma that caused ileocolic intussusception in a 69-year-old woman with no medical history. She underwent a small bowel resection and received six cycles of adjuvant chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Since then, she has been in complete remission.

Keyword

Intussusception; Primary small bowel lymphoma; Diffuse large B cell lymphoma

MeSH Terms

Adult*
Aged
Chemotherapy, Adjuvant
Colon
Constriction, Pathologic
Cyclophosphamide
Diverticulum
Doxorubicin
Female
Gastrointestinal Tract
Hemorrhage
Humans
Intestines
Intussusception*
Lymphoma
Lymphoma, B-Cell*
Lymphoma, Non-Hodgkin
Polyps
Prednisone
Rituximab
Vincristine
Cyclophosphamide
Doxorubicin
Prednisone
Rituximab
Vincristine

Figure

  • Fig. 1 (A) Intussusception can be seen (arrow). (B) Asymmetrical and concentric wall thickening called a ‘target sign’ (arrow) was observed and a leading tumor was suspected (asterisk).

  • Fig. 2 (A) Approximately 3×3 cm sized solid mass (arrow) originating from terminal ileum causing prolapse of the distal ileum into the ascending colon. (B) Intussusception was reduced by pushing the mass with biopsy forceps, and the mass originated from 20 cm above the ileocecal valve.

  • Fig. 3 Approximately 3×3 cm sized solid mass (arrow) was observed at the distal ileum.

  • Fig. 4 (A) Several large, pleomorphic, atypical lymphoid cells with abundant mitosis were present (H&E, ×100). (B) The tumor cells were positive for CD20 (CD20, ×400).


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